Differential Diagnosis for Epigastric Pain in the Morning
- Single most likely diagnosis
- Gastroesophageal reflux disease (GERD): This condition is often associated with morning epigastric pain due to stomach acid reflux into the esophagus, especially after lying down overnight.
- Other Likely diagnoses
- Peptic ulcer disease: Morning epigastric pain can be a symptom of peptic ulcers, which may be exacerbated by gastric acid production that peaks in the early morning.
- Gastritis: Inflammation of the stomach lining can cause epigastric pain, which may be worse in the morning due to overnight accumulation of stomach acid.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Myocardial infarction: Although less common, myocardial infarction (heart attack) can present with epigastric pain, especially in women, and is a critical diagnosis not to miss due to its high mortality rate if untreated.
- Pancreatitis: Acute pancreatitis can cause severe epigastric pain that may radiate to the back and worsen after eating, and its delayed diagnosis can lead to serious complications.
- Rare diagnoses
- Gastric cancer: Although rare, gastric cancer can cause epigastric pain, especially in older adults, and its early detection is crucial for effective treatment.
- Cholecystitis: Inflammation of the gallbladder can cause epigastric pain, especially after eating fatty foods, and may require urgent surgical intervention if severe.